Selecting, Implementing, and Evaluating Environmental and Population-Based Prevention
Strategies
How To Use Science in PracticeHow To Use Science in Practice
Selecting, Implementing, and Evaluating Environmental and Population-Based Prevention
Strategies
How To Use Science in PracticeHow To Use Science in Practice
Harold D. Holder, Ph.D.Prevention Research Center
Berkeley, California
GoalsGoals
Goal 1: Learn about population-based prevention Goal 1: Learn about population-based prevention approaches and “environmental strategies”approaches and “environmental strategies”
Goal 2: Learn what local prevention need to do in Goal 2: Learn what local prevention need to do in assessing, implementing, and evaluating assessing, implementing, and evaluating environmental strategies, i.e., strategic planning.environmental strategies, i.e., strategic planning.
Goal 3: Learn how to evaluate environmental Goal 3: Learn how to evaluate environmental strategiesstrategies
What are some popular beliefs What are some popular beliefs about environmental prevention about environmental prevention
strategies?strategies?1.1. Environmental strategies are difficult to Environmental strategies are difficult to
implement. Too costly.implement. Too costly.
2. Environmental strategies will not work in 2. Environmental strategies will not work in our community.our community.
3. We are already doing environmental 3. We are already doing environmental strategies.strategies.
4. ATOD abuse is more an individual problem 4. ATOD abuse is more an individual problem and environmental strategies are not and environmental strategies are not relevant.relevant.
5. Environmental strategies can not be 5. Environmental strategies can not be evaluated.evaluated.
6. Environmental strategies do not work with 6. Environmental strategies do not work with children and pre-teen youth.children and pre-teen youth.
Biggest Current Mistakes in Biggest Current Mistakes in Prevention?Prevention?
Doing many things that have little or no Doing many things that have little or no effect….effect….
““Not incorporating best prevention Not incorporating best prevention research into assessment, research into assessment, planning, and evaluation”planning, and evaluation”
Current Challenges and Opportunities Current Challenges and Opportunities for Preventionfor Prevention
Public Requirement of OutcomesPublic Requirement of Outcomes
Recommendation: Develop outcome data to show Recommendation: Develop outcome data to show resultsresults
Health Care ReformHealth Care Reform
Recommendation: Take advantage of emphasis on Recommendation: Take advantage of emphasis on prevention and outcomes in Health Care Reform prevention and outcomes in Health Care Reform documentationdocumentation
State Budget CutbacksState Budget Cutbacks
Recommendation: Demonstrate cost-effectivenessRecommendation: Demonstrate cost-effectiveness
Just What Just What IsIs Environmental Prevention, Environmental Prevention, Anyway?Anyway?
Environmental strategies in a community seek: Environmental strategies in a community seek:
1.1. To bring about system-level change (including To bring about system-level change (including physical space, local community policies, physical space, local community policies, availability of drugs and alcohol, etc.) availability of drugs and alcohol, etc.)
in order in order
2.2. To reduce substance abuse problems at the To reduce substance abuse problems at the population level. That is population level. That is Public Health.Public Health.
Both conditions must be met.Both conditions must be met.
Substance-related
consequences and substance
use
Intermediate variables
Programs/ policies/practices
Implementing the Strategic Prevention Framework
Planning, Monitoring, Evaluation, and Replanning
Outcomes-Based PreventionOutcomes-Based Prevention
States are familiar with logic models:States are familiar with logic models:
Tools for assessing, planning, Tools for assessing, planning, implementing, and evaluating prevention.implementing, and evaluating prevention.
Logic models are composed of:
3. Intervention strategies to change intermediate variables.
1. Prevention goal, i.e., specific ATOD outcome to be reduced or changed
2. Intermediate variables or factors, which need to be changed (or considered) in order to achieve the goal
Example Logic Model for Substance Abuse Prevention
Alcohol-Related Traffic
CrashesAmong 15- to 24-Year-Olds
Youth Frequent Exposure to Internet
School Bonding for Youth
Awareness of Risk of Drinking
Increased Abstinence
Family Training
Public Education About Drinking and Driving
Risks
Perceived Risk of Drinking and Driving
Enforcement
School Drug Resistance Training
Underage and Young Adult
Driving After Drinking
Highly Visible DUI Enforcement
Responsible Beverage Service To Reduce Overserving
Youth 30-Day Cannabis Use
Number of DUI Arrests
Intermediate Variables
StrategiesSubstance-
Related Consequences
SubstanceUse
Low Personal Self-Esteem
Youth and Young Adult
Lifetime Drinking
Underage and Young Adult
Binge Drinking
What is wrong with this picture?
Alcohol Sales and Service Regulations, Enforcement, and
Sanctions
Alcohol Serving and
Sales Practices
Drinking
Price
Community Norms– Drinking
Drinking Context
DUI Enforcement
Public Awareness of Drinking/Driving Enforcement
Community Norms–
Drinking and Driving
Driving After DrinkingAlcohol-RelatedMotor Vehicle
Crashes
Individual Factors
Social Availability
Retail Availability
Alcohol-Related Motor Vehicle Crash Model
Perceived Risk of DUI Arrest
Strong Relationship
Moderate Relationship
Minor Relationship
Little Research Evidence but Logical Relationship
Research Evidence
Review of Research Evidence forReview of Research Evidence for Logic Models Logic Models
WWW.PIRE.orgWWW.PIRE.org
Under “Under “Featured Websites” to “Logic Models Featured Websites” to “Logic Models for the Prevention of Alcohol, Tobacco, and for the Prevention of Alcohol, Tobacco, and
Other Drug Problems,Other Drug Problems,””select tab in right-hand column.select tab in right-hand column.
Underage Drinking Logic Model
Underage drinking
Social availability of alcohol to youth (parties, peers,
families)
Retail sale of alcohol to youth
Underage drinking
laws
Community concerns about youth drinking
Visible enforcement
Compliance checks, citations, license loss
Party patrol,shoulder taps,
beer keg registration
Legal risks for providing alcohol to underage youth
Retailer training & rewards
Local alcohol policy
Media advocacyMedia advocacy
Price
Discount bans
Examples of Effective Local Prevention Examples of Effective Local Prevention Projects Utilizing Environmental Projects Utilizing Environmental
StrategiesStrategies
National Community Trial To Prevent National Community Trial To Prevent Alcohol-Involved TraumaAlcohol-Involved Trauma
OrangeOrange
OceansideOceanside..
..
..
-
ExperimentalExperimentalComparisonComparison
ModestoModesto
SalinasSalinas
FlorenceFlorence
SumterSumter
Alcohol-Involved Trauma at the Community Level: Alcohol-Involved Trauma at the Community Level: Logic Model`````````Logic Model`````````
MOBILIZATIONMOBILIZATIONMOBILIZATIONMOBILIZATION DRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVING
UNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKING
ALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESS
RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE
RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE
Non-Traffic Risk ActivitiesNon-Traffic Risk Activities
Local News About AlcoholLocal News About AlcoholProblems and EnforcementProblems and Enforcement
Retail Alcohol Retail Alcohol AvailabilityAvailability
(on- and off-premise)(on- and off-premise)
Alcohol IntoxicationAlcohol Intoxication or Impairmentor Impairment Alcohol-InvolvedAlcohol-Involved
Injury Injury
Alcohol-InvolvedAlcohol-InvolvedInjury Injury
Driving AfterDriving AfterDrinkingDrinking
Perceived Perceived Risk of ArrestRisk of Arrest
Local LawLocal LawEnforcementEnforcement
Social Access Social Access to Alcoholto Alcohol
Alcohol Alcohol Serving and Serving and
Sales PracticesSales Practices
Local Regulation Local Regulation of Alcoholof Alcohol
(density, hours (density, hours of sale)of sale)
Restaurant Service Restaurant Service
Highly visible and increased actual drinking and driving
enforcementenforcement
Underage Drinking
In Salinas California, 90% of students who drink report attending parties where minors drank.
Intermediate Variable and Strategy Data
Underage Alcohol Prevention Activities
0
20
40
60
80
100
120
140
160
Q2 Q3 Q4 Q1 Q2
ENFORCEMENTVISITS
CITATIONSISSUED
OUTLETSTRAINED
“Mountain of Beer”
Underage Alcohol Purchase SurveyExperimental and Comparison Communities
0
10
20
30
40
50
60
Perc
en
t S
ellin
g
4747 4545
5353
3535
19191616
Comparison
ExperimentalNo Training
ExperimentalTraining
Comparison
ExperimentalNo Training
ExperimentalTraining
PRETEST PRETEST POSTTESTPOSTTEST
Holder, et al., Holder, et al., J. American Medical Association,J. American Medical Association, 2000 2000
OutcomesOutcomes
What were final results?What were final results?
Examples of Community Action Projects Examples of Community Action Projects for Environmental Preventionfor Environmental Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • DUI enforcementDUI enforcement •• Alcohol service Alcohol service •• News coverage News coverage •• Underage sales Underage sales •• Alcohol outlets Alcohol outlets
United StatesUnited States
California,California,South CarolinaSouth Carolina
Reduce alcohol Reduce alcohol injury and deathinjury and death
10% reduction in 10% reduction in alcohol crashesalcohol crashes
43% reduction in 43% reduction in violenceviolence
Lower alcohol Lower alcohol sales to youthsales to youth
• • News coverageNews coverage•• DUI enforcement DUI enforcement•• Alcohol outlet Alcohol outlet surveillance surveillance
MassachusettsMassachusetts Reduce alcohol Reduce alcohol crashescrashes
25% reduction in 25% reduction in fatal crashesfatal crashes
•• Local sales policies Local sales policies and enforcement and enforcement
MinnesotaMinnesota Reduce youth Reduce youth drinkingdrinking
Lower alcohol Lower alcohol sales to youthsales to youthReduced traffic Reduced traffic crashescrashes
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • Responsible Responsible Beverage Service Beverage Service
• • Joint parent/police Joint parent/police enforcement of enforcement of sales to youthsales to youth
• • Club policy and Club policy and drug recognition by drug recognition by door securitydoor security
Reduced local Reduced local alcohol and alcohol and drug problemsdrug problems
Reduction in sales to intoxicatedpatrons (47% to 5%)
Violent crime down by 29%
• • Community forum Community forum and alcohol safety and alcohol safety auditaudit
• • Model house policiesModel house policies •• Increased enforce-Increased enforce-
ment of alcohol-ment of alcohol-licensed premiseslicensed premises
AustraliaAustraliaSurfers Surfers Paradise Paradise Safety Action Safety Action ProjectProject
Lower Lower alcohol- alcohol- involved involved violenceviolence
Reduction in Reduction in violent events: violent events: original siteoriginal site from from 9.8 to 4.7 and9.8 to 4.7 and
Refusals of drug Refusals of drug impaired patrons impaired patrons increased by 300%increased by 300%
replication sitesreplication sites from 12.2 to 3.0from 12.2 to 3.0
SwedenSwedenSTAD Project Stockholm
What Have We Learned to This Point?What Have We Learned to This Point?
Environmental prevention can produce measurable results.Environmental prevention can produce measurable results.
Environmental strategies must be selected that have been Environmental strategies must be selected that have been shown to work—that is, impact shown to work—that is, impact keykey intermediate variables. intermediate variables.
Logic Model in environmental prevention must be based on empirical evidence about intermediate variables.
Do few things well. High “dosage” to be effective.Do few things well. High “dosage” to be effective.
NextNext
Learn tools and approaches to monitor and Learn tools and approaches to monitor and evaluate environmental strategies.evaluate environmental strategies.
Discuss ways for communities in more effective Discuss ways for communities in more effective in environmental prevention.in environmental prevention.